Let's Finally Get the Fundamentals of Healthcare in Place in Africa

Skoll World Forum
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Editor’s Note: Andrea Coleman is co-founder and CEO of Riders for Health, an international social enterprise that manages and maintains vehicles for health care in sub-Saharan Africa enabling health workers to deliver vital health care to rural communities on a reliable and cost-effective basis.

This statement applies as much in development as it does in any other environment. And the lack of success in achieving the Millennium Development Goals – three and four in particular – can certainly be said to be a result of the fact that we all seem to have overlooked the basic fundamentals of health care. If we are going to tackle health care for millions of people across Africa we must first tackle the most basic elements of any health system: logistics, maintenance, local skills and communications.

Isn’t it obvious that to have predictable and routine health care these must be in place? Otherwise, we are trying to build on sand or air or something equally insubstantial. Until we put these fundamentals in place no routine public health, nor curative health, can be carried out predictably, cost effectively and reliably. The millions of people living in rural Africa will remain the victims of distance and terrain. Victims of a lack of appropriate infrastructure.

On Sunday 7 April, ‘UN World Health Day’ will focus on high blood pressure and its associated outcomes such as heart disease and strokes. GA Mensah, in ‘Heart’, published in the British Medical Journal in 2008, says ‘prevalence of the disease [is] consistent with the nutritional and epidemiological transition in the region (Africa). Renewed emphasis on improved surveillance and the prevention and control of high blood pressure and stroke in Africa is needed’.

This is important advice. However, there is just a small problem here. Has anyone thought of the physical access to the millions of real people in real places and just how fundamental this is? Of just how difficult is it to reach them? All health care depends on a health system. I think that it’s about time that we focused a World Health Day on physical health systems; on the fundamentals.

If you don’t get maintenance and local skills – the fundamental building blocks – in place there is nothing for the smart new developments in health to be built on. As Randy Pausch said: ‘Fundamentals, fundamentals, fundamentals. You’ve got to get the fundamentals down because otherwise the fancy stuff isn’t going to work.’

For example, when I attend conferences or talk to people about improving health care in the developing world perhaps the first thing that is mentioned is introducing more and more mobile and internet technology.

There is no doubt that cell phones are transforming lives in Africa. They are putting people in remote communities in touch with the outside world. They are giving people access to services like banking for the first time ever. In many ways countries like Kenya are leading the developed world in this area.

And when it comes to health care mobile technology can have a huge impact. It can improve communication on stock levels, it can assist in monitoring disease outbreaks, and it can help in delivering test results. But in each of these cases the mobile is only half of the solution. The drugs must still be delivered from the warehouse to the clinic so they are there for the pregnant mother who has walked for three hours to the clinic. The health worker must still reach the disease stricken village. The specimens for diagnosis must still reach the laboratory to be tested.

These things must happen with or without new technology. They are fundamental. New technology can only ever offer improvements on the way things are done, it cannot be a substitute. And, by believing it can, we are wasting time, money and lives.

Six-out-of-ten people in sub-Saharan Africa live in rural communities. Often these communities lack regular access to electricity or fuel. A mobile phone will allow them to phone a health worker, but if the health worker has no way of reaching them then they will still not receive treatment.

The incredible advances that have been made to medicine and health care in the developed world over the past 100 years have been based on continuous development, on marginal improvements, each one driving the next advance and each one building on the last, until we have reached the stage we are at now. In the case of development in Africa it seems like we are trying to implement the latest advance in medical technology on to a system that is not in a position to support them.

I am not saying that we should not want the latest development to be available in Africa. God knows it is needed. I want to see a world where the best health care is available to everyone, no matter where they live. But to do that we need to make sure the building blocks are all in place to support it.

That is why trained mechanics with greasy hands should be an integral part of every health system.

And, there is no reason why this should take as long in Africa as it did in developed countries. We know what the building blocks look like now, and while it may take some creativity to fit them together in different contexts in Africa, it is surely not beyond humanity’s wit to do it?

But what we simply cannot do is to ignore those fundamentals. Without them not only will we not have the impact that we are looking for from our health interventions – we will simply be wasting money. Ultimately, people will suffer because the health care they need does not reach them.

So, I think that my wish on this World Health Day is for the world to commit to focusing on the fundamental elements of any health system. Not at the expense of ignoring the innovative, rather that we make sure we build innovation on to solid foundations and that, finally, people across the world get access to the health care they need.